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Despite billions of dollars in settlements with regulators, drugmakers continue to sidestep the rules when it comes to marketing their medicines.

Pressure on drugmakers to deliver short-term revenue and profit growth has led to some suspect practices in the industry that have resulted in billions of dollars in fines and settlements, and are likely to result in billions more.

According to a 2014 article in Nature Biotechnology, 11 pharmaceutical companies, including giants Johnson & Johnson and Merck, paid over $13 billion in fines between January 2009 and February 2014.

Kristine Harjes: An even more common instance in which regulators are getting their hands involved in this regards marketing practices. You've seen a ton of instances where pharmaceutical companies have to pay for either not disclosing safety risks or marketing a drug off-label, meaning not for its actual approved indication. I saw one estimate that from January 2009 through February 2014, 11 pharmaceutical companies agreed to pay over $13 billion in fines, and this was for all sorts of allegations. All the previously mentioned ones about your misleading marketing practices, failure to report data, all that kind of liabilities.

Todd Campbell: It's a staggering number. Staggering! I mean, you're talking about billions of dollars that the industry is willing to pay in fines, and the fact that they're continually having to pay these fines suggests to me that they're approaching it as business as usual.

"OK, well, we'll go out, we market the drug, we spend a lot of money marketing these drugs," $27 billion in 2012 was spent promoting drugs, either in person to doctors or on the airwaves, if you will. This is just one more piece of that puzzle. It's a cost of doing business. We'll pay the fine because we're out there marketing these drugs, and that's how we're going to grow our sales and our profit.

Harjes: Yeah. It's kind of alarming, when you consider that this is just the cost of doing business. There has been a little bit of conversation about maybe tightening restrictions on the way that you can market. There's a conversation going on about potentially eliminating TV ads that are direct to consumer. I can kind of see that argument too, that you don't want to be marketing a disease, you want to be marketing the drug.

Even then, you kind of don't want people asking for a brand name specifically when A) there might be a generic equivalent out there, or B) that might not be the best drug for them. If you go with your doctor, and you're like, "Oh, I saw this TV ad, I want Drug X, it looks great," but that's not really the best drug for you, the doctor has a dilemma there, because he doesn't want to upset the patient, and if something goes wrong, possibly find himself in trouble, but he also wants to also prescribe the best drug for you.

Campbell: Yeah. You've got that aspect of it. You also have the whole concept of, if a drug is on the market ... investors should know this: If a drug's on the market, a doctor can prescribe it for something that's not on the drug's label. That part of it is OK. Say that you've got a pain drug that's approved for cancer, and peer-reviewed journals or whatever show that it also helps relieve back pain. As a doctor, you can prescribe it for back pain if you choose. However, a company that manufactures that pain drug can't start marketing it to all of these doctors to start using as a pain drug for lower back pain. You can't do that.

A lot of this off-label marketing is what's, I guess, causing these settlements, the billion-dollar settlements. You've got a lot of different issues on this front that I think you could argue aren't as efficient as they should be for creating long term shareholder value, and it's all more geared toward creating short term value for Wall Street investors.